The effect of the application of cold on hematoma, ecchymosis, and pain at the catheter site in patients undergoing percutaneous coronary intervention

Objective: This study was conducted to determine the effect of the application of cold on hematoma,ecchymosis,and pain in patients undergoing percutaneous coronary intervention.Methods: It is a quasi-experimental study with a control group.A total of 200 patients (100 in the control group and 100 in the experimental group) were included in the research.In the experimental group,a cold pack was applied to the bottom of the sandbag for the first 15 min after withdrawing the femoral arterial catheter.Both groups were assessed and followed up at the first 15th minute and 4th,48th and 72 nd h.Results: After the femoral arterial catheter was withdrawn,ecchymosis and hematoma were smaller and pain was less in the experimental group at the catheter entry site compared to the control group,and the difference was statistically significant (P < 0.01).Conclusion: It was determined that the application of cold reduced the formation of hematomas,ecchymoses and pain in patients after the withdrawal of the femoral arterial catheter.

Iliac ecchymosis,a valuable sign for hollow viscus injuries in blunt pelvic trauma patients

Purpose:Pelvic fractures are characterized by high energy injuries and often accompanied with abdominal and pelvic organ injury.CT has been applied for several decades to evaluate blunt pelvic trauma patients.However,it has a certain rate of inaccurate diagnosis of abdominal hollow viscus injury(HVI),especially in the early stage after injury.The delayed diagnosis of HVI could result in a high morbidity and mortality.The bowel injury prediction score(BIPS)applied 3 clinical variables to determine whether an early surgical intervention for blunt HVI was necessary.We recently found another clinical variable(iliac ecchymosis,IE)which appeared at the early stage of injury,could be predicted for HVI.The main objective of this study was to explore the novel combination of IE and BIPS to enhance the early diagnosis rate of HVI,and thus reduce complications and mortalities.Methods:We conducted a retrospective analysis from January 2008 to December 2018 and recorded blunt pelvic trauma patients in our hospital.The inclusion criteria were patients who were verified with pelvic fractures using abdomen and pelvis CT scan in the emergency department before any surgical intervention.The exclusion criteria were abdominal CT insufficiency before operation,abdominal surgery before CT scan,and CT mesenteric injury grade being 5.The MBIPS was defined as BIPS plus IE,which was calculated according to 4 variables:white blood cell counts of 17.0 or greater,abdominal tenderness,CT scan grade for mesenteric injury of 4 or higher,and the location of IE.Each clinical variable counted 1 score,totally 4 scores.The location and severity of IE was also noted.Results:In total,635 cases were hospitalized and 62 patients were enrolled in this study.Of these included patients,77.4%(40 males and 8 females)were operated by exploratory laparotomy and 22.6%(8 males and 6 females)were treated conservatively.In the 48 patients underwent surgical intervention,46 were confirmed with HVI(45 with IE and 1 without IE).In 46 patients confirmed without HVI,only 3 patients had IE and the rest had no IE.The sensitivity and specificity of IE in predicting HVI was calculated as 97.8%(45/46)and 81.3%(13/16),respectively.The median MBIPS score for surgery group was 2,while 0 for the conservative treatment group.The incidence of HVI in patients with MBIPS score≥2 was significantly higher than that in patients with MBIPS score less than≤2(OR=17.3,p<0.001).Conclusion:IE can be recognized as an indirect sign of HVI because of the high sensitivity and specificity,which is a valuable sign for HVI in blunt pelvic trauma patients.MBIPS can be used to predict HVI in blunt pelvic trauma patients.When the MBIPS score is≥2,HVI is strongly suggested.

Severe Henoch-Schonlein purpura with infliximab forulcerative colitis

Infliximab （IFX） is an anti-tumor necrosis factorchimeric antibody that is effective for treatment ofautoimmune disorders such as Crohn＇s disease andulcerative colitis （UC）. IFX is well tolerated with alow incidence of adverse effects such as infections,skin reactions, autoimmunity, and malignancy.Dermatological manifestations can appear as infusionreaction, vasculitis, cutaneous infections, psoriasis,eczema, and skin cancer. Here, we present anunusual case of extensive and sporadic subcutaneousecchymosis in a 69-year-old woman with severe UC,partial colectomy and cecostomy, following her initialdose of IFX. The reaction occurred during infliximabinfusion, and withdrawal of IFX led to gradual alleviationof her symptoms. We concluded that Henoch-Sch？nleinpurpura, a kind of leukocytoclastic vasculitis, mighthave contributed to the development of the bruising.Although the precise mechanisms of the vasculitis arestill controversial, such a case highlights the importanceof subcutaneous adverse effects in the management ofUC with IFX.

Dexamethasone’s Effect on Post-Rhinoplasty Periorbital Edema

Introduction: The efficacy of dexamethasone in reducing periorbital edema and ecchymosis following rhinoplasty was investigated in a double-blind, randomized trial. Materials & Methods: The study comprised fifty-four rhinoplasty patients who underwent open rhinoplasty surgery with tip modification, hump excision, and bilateral osteotomy and were divided into three groups: Group one: 18 patients: a single dosage of 8 mg dexamethasone given at the start of the procedure. Group two: 18 patients: three 8 mg dexamethasone doses given at the start of the procedure, then 24 and 48 hours afterwards. Group 3: a control group of 18 patients who were not given any medication. Result: In comparison to control group 3, there was a significant reduction in periorbital edema and ecchymosis in groups l and 2. Group 2 had less periorbital edema and ecchymosis at the end of the first postoperative week than group 1. Conclusion: Edema and ecchymosis were significantly reduced with dexamethasone administration in rhinoplasty with osteotomy. Use of three doses of dexamethasone can reduce edema and ecchymosis after rhinoplasty more than the single dose treatment during the first postoperative week.

Optimal intensity and duration of cupping for minimizing possible mechanical skin deformation

OBJECTIVE:To identify the optimal intensity and duration of cupping that would minimize mechanical skin deformation.METHODS:We developed an optical measurement probe and system for measuring skin color values in real time.We applied cupping at the following five Bladder Meridian acupoints.To investigate optimal intensity,negative pressure intensity was increased every 2 min up to 80 k Pa.To investigate optimal time,10 measurement sites were selected and negative pressure intensities of 30,60,and 80 k Pa were applied for 5 min each.Skin color information was analyzed by the following skin color values:red color saturation,erythema index,and melanin index.RESULTS:The red color saturation and erythema index increased steadily up to 60 kpa negative pressure intensity,then decreased between 60 and 80 k Pa.Therefore,maximal values were observed at 60 k Pa.The melanin index consistently increased with increasing negative pressure intensity.The red color saturation and erythema index did not change after 20 s at 60 k Pa negative pressure intensity.For negative pressure intensities below 80 k Pa,significant changes in melanin index were not observed after 20 s.At 80 k Pa negative pressure intensity,the melanin index exhibited an increasing pattern for200 s,then showed no changes.CONCLUSIONS:To minimize skin deformation,60 k Pa and 20 s were the appropriate intensity and duration when using red color saturation and erythema index as diagnostic indexes.Because of the increasing pattern up to 80 k Pa negative pressure intensity,the optimal intensity of melanin index could not be determined.When applying 80 k Pa negative pressure intensity and using melanin index as the diagnostic index,we recommend a duration of 200 s.